1. Management and Care of Offenders with Learning Disabilities Kate Davies OBE Head of Public Health, Armed Forces and their Families & Health & Justice 7 October 2014

2. TO COVER: 2 The delivery of the (relatively) new Liaison and Diversion services The processes by which such services should begin to identify people with learning disabilities when they first come into contact with the Health & Justice system The ways of ensuring the necessary support is in place as they travel through the justice system (or are diverted away from it) Learning Disability – ensuring we here and act on the service user voice

3. Health & Justice Commissioning Context £472 million budget Commissioned by 10 Lead Area Teams One Health & Justice Clinical Reference Group Mixed market of providers – NHS Trusts, independent and private sector Strong mental health links including substance use Patients are offenders, victims, detainees and families Support reduction of offending behaviour Strong partnership governance and reliance Patient voice essential to monitor quality and integration of patient pathways Through the Gate 3

4. What We Commission? NHS England is responsible for planning and commissioning health services including the public health of people in Detained and Secure Settings across a range of justice services’ sites: -Prisons; -Young Offender Institutes; -Secure Children’s Homes; -Police Custody Suites; -Immigration Removal Centres; -Liaison & Diversion Service, Police Custody and Courts; -Sexual Assault Referral Services; -Public Health in Detained and Secure Settings Key documents are ‘Securing Excellence in Commissioning for Offender Health’ published in January 2013 and Health & Justice Commissioning Intentions published May 2014 and updated on a yearly basis 4

5. In order to discharge NHS England’s responsibilities, we agree with partners including the Ministry of Justice, National Offender Management Service and Police Services the specific nature of services to be commissioned, agree quality standards, secure appropriate funding for these services, and ensure services are delivered to quality standards Services are commissioned by 10 Lead Area Teams on behalf of the 27 Area Teams across NHS England Our 10 Lead Area Teams enter into local agreements with local partners, particularly Clinical Commissioning Groups and Local Authorities to establish where pooled budgets and co-commissioning arrangements will maximise efficient use of resource and expertise How We Commission 5

6. How We Commission? Partnership Agreements are established and commissioning decisions are taken together with our partners. -The Home Office Immigration Enforcement Partnership Agreement -The Ministry of Justice, Youth Justice Board Partnership Agreement -The Ministry of Justice, National Offender Management Service Partnership Agreement (in conjunction with Public Health England) Health Needs Assessments in Partnership with Public Health England across secure estate -A national Health Needs Assessment with 10 Immigration Removal Centres across England is taking place. This is a joint venture between NHS England and the Home Office to inform the health care commissioned in 9 Immigration Removal Centres in England 6

7. Commissioning Features (England) CCG’s (211) LA’s (152) 4 Regions NHS England Commissioning of primary care for general population Commissioning of health services for people in ‘prison and other places of detention’ Specialist care Armed Forces and their Families Health Elements of Public Health Commissioning majority of healthcare services for the general population, including secondary care Commissioning majority of health services for offenders managed in the community or released from custody e.g. Children & young people on court orders and released from secure estate, adult offenders managed by Probation Key strategic and planning role in bringing together local authorities, the local NHS and communities (with other key partners) to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) to underpin local commissioning plans and service planning Health and Wellbeing Boards (152) Commissioning of public health, and social care services, for the general population including substance misuse services Commissioning public health and care services for offenders managed in the community or released from custody e.g. Drug and alcohol treatment services for offenders not in prison or places of detention 7

8. Putting Patient First: Objectives Ensure equitable access to effective treatments for the health and justice patient cohort across England Continue to promote continuity of care from custody to community 8

9. Why the focus on this population? 24% ‘looked after children’ in Young Offenders Institutes 40% admitted have no community based GP 72% male and 70% female sentenced prisoners suffer from two or more mental health disorders. 77% sentenced men and 82% sentenced women smoke 85% older prisoners have had one or more major illness 81% those entering prison report they have taken drugs (40% report injecting within 28 days before custody) Heroin and crack cocaine use higher amongst women (44% and 49% respectively ) than men UK study of prisoners and HIV identified 75% male 69% adult female prisoners injecting drugs had shared needles 9

10. Early intervention in criminal justice processes -Identification, assessment and referral Integrated model for children, youths and adults Targeting a range of vulnerabilities such as -Mental Health, Learning Disability, Substance Misuse -Social issues, Housing, Education… Provision at Police Custody and Courts Hours to suit operational requirements Range of referral pathways to suit identified issues Liaison & Diversion Core Model

11. Liaison and Diversion points of operation Identification Criminal justice agencies, such as police and courts, are trained to identify signs that an offender may have a learning disability, mental health issue, drug and substance misuse or other vulnerability. Screening and assessment Specialist workforce, such as L&D practitioners with learning disability expertise, carries out an assessment to identify the offenders needs and if they should be referred onwards to treatment or further support. L&D services can also call for a specialist assessment and when a specialist expertise doesn’t exist, there is an opportunity include them into the L&D workforce. Referral Offenders needing further support and treatment will be referred into appropriate services, such as learning disability services.

12. Expansion of Liaison & Diversion Services Fully specified services Existing L&D services No cover KEY

13. 50% coverage from April 2015 Evaluation report from RAND Europe Full Business Case to Treasury in autumn 2015 Achieve 100% coverage by 2017/18 subject to approval of a Full Business Case Opportunity to consider wider integration: Liaison & Diversion, Police Healthcare, Street Triage Enhanced quality of service, scale economies Consider further evaluation of long-term impact Future of Liaison & Diversion Services

14. Street Triage – The Current Picture 9 Pilots Approx 25 schemes across the country Positive outcomes Sustainability is issue for most Forces 14

15. Street Triage – The Future Integration with Liaison & Diversion and Police Custody Healthcare Street Triage Mapping. Ensuring consistency and sustainability of available Street Triage across England Options for future commissioning Core Definition Service Specification / Operating Model to support quality and patient pathways Health & Justice Information Management 15

16. Securing Excellence in IT Services for Health & Justice Develop Health & Justice Information Systems to support data sharing across health and criminal justice pathways and to improve access, identify gaps in provision and improve quality of care. NHS England is now leading the development of a major programme to develop and improve Health & Justice Information Programme. -Phase 1, improvement of patient and information within secure settings -Phase 2, to develop Health & Justice Information Systems across all pathways of care including Police Custody, Liaison & Diversion and Childrens Secure -Phase 3, to develop a stronger focus on social care and a Full Business Case for the second generation Health & Justice Information System 16

17. Putting Patients First: Key Deliverables The programme for Liaison & Diversion services at police custody suites and criminal courts implemented, with incremental growth in service cover to 100% by April 2017 A review of health services currently commissioned across the secure estate to ensure it meets the patient population needs of the reconfigured estate as part of ongoing health needs assessment delivery in train with the transforming rehabilitation timetable, starting in October 2014 A ‘Through The Gate’ recovery programme implemented across the secure estate with a particular emphasis on the patient care of those individuals who misuse and are dependent upon harmful substances 17 A strategic plan for Health & Justice services to ensure a five year forward plan

18. Where do we want to be Health & Justice Strategic Priorities – 5 Year Strategy Make high quality care for all, now and for the future generations into reality for health & Justice patients and their families To reduce Health Inequalities and improve health outcomes for people across detained and secure settings Contribute to the reduction of offending behaviour by supporting better health outcomes for the patient population Strengthen leadership and the patient voice to inform and improve the efficiency and effectiveness of services we commission, with active Health & Justice patient and public involvement Develop and deliver national standards and service specifications to a Single Operating Model for Health & Justice commissioning Collaborate with Clinical Commissioning Groups, Police Crime Commissioners and Health & Wellbeing Boards to develop and ensure that all Health & Justice patients receive appropriate care regardless of commissioner 18

19. Health & Justice Strategic Priorities – 5 Year Strategy Improved patient pathways and continuity of care for offenders, victims and their families including the interface with Through the Gate substance misuse programme Improve the health outcomes for the patient cohort commissioned by the Health & Justice Direct Commissioning including Mental Health, Substance Misuse, Learning Disabilities and victims of rape and sexual assault Promote Mental Health Liaison & Diversion service across England. Improve crisis access and whole system approach for Parity of Esteem for adults, children and young people Commission Health & Justice services with lead providers and the option for sub- contracting models to support rationalised and consolidated provider landscape to support continuity of care, quality of provision and best value Meet affordability challenges, with better uses of resources through commissioning and financial governance Deliver health & social care for offenders and victims against the principles of equivalence and inclusion Potential to make use of third sector provision Cont/…. Where do we want to be 19

20. Conclusion The patient voice is key whether offender, victim or family and carer. The funding, information and patient data need to follow the individual to ensure integrated pathways to support and achieve reduction of offending behaviour, victim support and reduce Health Inequalities. 20

21. Questions? 21